Do patients with B-cell lymphoma respond properly to the Pfizer BioNTech COVID-19 vaccine?

This study looked at the use and response of the Pfizer BioNTech COVID-19 vaccine in patients with B-cell non-Hodgkin lymphoma (NHL). It found that patients with NHL undergoing treatment with rituximab (Rituxan)/obinutuzumab (Gazyva) had a poorer immune response to this vaccine, compared to patients without lymphoma.  

B-cell NHL is a cancer affecting the immune system. B-cells are cells that fight infection. Treatment for B-cell NHL involves medications that latch on to the B-cells and trigger the immune system to kill these cells. Two of these medications are rituximab and obinutuzumab. These medications dampen the immune system by attacking the B-cells.

The Pfizer BioNTech (BNT162b2) vaccine teaches the immune system to recognize the COVID-19 virus. When the immune system is not working properly, there is concern that the vaccine will not work properly. Vaccine response can be assessed by measuring the amount of antibodies produced against covid-19. There is not much information regarding how patients with NHL respond to the BNT162b2 vaccine and if treatment for NHL affects this response. 

214 participants were involved in this study. This included 149 patients with B-cell NHL and 65 healthy participants without lymphoma (control group). Patients with NHL were divided into 3 groups. Group 1 (39 patients) were currently undergoing rituximab/obinutuzumab treatment. Group 2 (69 patients) had completed rituximab/obinutuzumab treatment more than 6 months before vaccination. Group 3 (28 patients) had never had rituximab/obinutuzumab treatment.

 All participants received the Pfizer BioNTech vaccine, 2 doses, 21 days apart. Antibody levels were measured to assess vaccine response 2-3 weeks after the second vaccine dose. A positive (successful) vaccine response was determined by antibody levels of 0.80 U/mL or more.

49% of patients with B-cell NHL achieved a successful vaccine response, compared to 98.5% of patients without lymphoma. Participants in the control group also had significantly higher levels of antibodies compared to the NHL group.

Comparing results amongst the lymphoma groups; 7.3% of group 1 patients achieved a successful vaccine response, compared to 66.7% of group 2, and 89% of group 3. Patients in group 3 had significantly higher levels of antibodies compared to group 2. 

Side effects were reported in 51% of 118 patients available for safety evaluation. The most common side effects were pain at the injection site (37.7%), tiredness (19.5%), and muscle pain (9.3%). There were no severe side effects in either group and side effects did not differ between patients with NHL and healthy participants. 

This study showed that response to the Pfizer BioNTech vaccine is impaired in patients with B-cell non-Hodgkin lymphoma. This is related to rituximab/obinutuzumab treatment. The longer time that has passed since this treatment, the more likely patients were to achieve a successful response to this vaccine.

This study involves a relatively small number of patients. Larger studies are needed to confirm these findings.